December 19, 2012

by Carmen Nobre,
Pharm.D., PGY2 Oncology Resident, University of Maryland

Lines between being a preceptor and mentor often
blur. To be a preceptor is to
participate in a prearranged role where one assumes the responsibly of fostering
and building the core professional skills of a trainee. As outlined by American Society of
Health-System Pharmacists for pharmacy post-graduate residency programs1,
a preceptor is one that models, coaches, and facilitates a trainee's performance as a
professional.

To be a mentor is to function as a role model
within your given profession. Research on mentoring
indicates that a mentor should:2

·be nurturing

·be a role model

·function as teacher, sponsor, encourager, counselor and friend

·focus on the professional development of the mentee

·sustain a caring relationship over time

This type of relationship is traditionally
freely entered by both parties (i.e. not as a requirement of a curriculum or
program). The mentor and mentee build a
closer, more personal relationship than that of a preceptor and student. Of no surprise, this often means that the two
parties share similar interests and characteristics. A mentor may participate in professional
activities with the trainee, and may also engage in discussions relating to the
trainee as an individual and not solely as a member of a larger group of
professionals. Topics of discussion often
include families, hobbies, frustrations, and ambitions.3

Despite their differences, the
terms preceptor and mentor are often interchanged. This may be due to their shared goal of
fostering the development of a young professional. Yes, both roles have the common goal of
guiding a trainee in their professional development, and coaching them through
their journey. Each role may also serve
to challenge the trainee, evaluate their performance, or offer advice. However, there exists a different tone
between these relationship. Most obvious
are the differences in the goals and benefits of these relationships, their
duration, the socialization process, the support for learning and feedback
given.4 Simply put, a
preceptor is more of an authoritative figure while a mentor acts more like an
older sibling.

Can these lines ever be blurred? Should they be blurred? If so, when is it appropriate to play this
dual role? Furthermore, how do you
juggle between the two? Playing this
dual role can be tricky. As a preceptor
there is a responsibility to evaluate the trainee, and provide constructive
feedback to further their growth. But as a mentor there is an expectation that
you offer support and advice in how to handle even the worst of
situations. Is it possible to provide
necessary criticism while being supportive?

In my experience, it can be difficult for both the
preceptor / mentor to have this overlapping relationship. From the trainee's perspective, it is difficult to maintain a goal-oriented
working relationship with a preceptor, and then switch modes and disclose personal
thoughts and feelings to that person.
In addition to identifying when it is appropriate to have a mentoring discussion,
it is also difficult to reveal your weaknesses and frustrations (or even
pleasant feelings) to a person who will be evaluating your performance. From the preceptor’s perspective, it must be
difficult to transition between nonjudgmental casual conversations and to
formal discussions and evaluations of the trainee's performance. Although it may be possible to carry this
dual role, it requires a certain degree of balance.

Nonetheless, the benefit of having a mentoring
relationship with a resident outweighs the risk of blurring the line between
being a preceptor or a mentor. There is
much to gain. There are opportunities to
exchange ideas, improve job satisfaction, and build networking
relationship. Many institutions have
developed formal mentoring programs where the mentor and mentee are paired and
given guidance about how to develop an effective relationship.5

Creating a formal mentoring program is one
way of incorporating this fundamental practice into a resident's
experience. Another way is to purposely integrate
it into the objectives of the residency curriculum. By including instruction about mentoring, it will
clarify the intent and expectations of the mentor-mentee relationship, and
would also ensure that important professional development topics are addressed
during the year. This would serve to
establish goals and clarify expectations (such as frequency of meetings). An example: mentors should set aside time to discuss potential career
opportunities after residency. It is
important to keep in mind the fundamental distinction between being a preceptor
and a mentor, and that any relationship requires effort from both parties to be
successful.6

Learning to be an effective preceptor and mentor requires
training for a successful and positive experience. As a recent graduate and having precepted my
first student, I commend those who are able to fulfill these dual roles. However, I would encourage new preceptors and
mentors to have an open exchange with their
trainees about expectations, and even seek advice from more experienced mentors
(i.e. become a mentee yourself).

by Taemi Cho,
Pharm.D., PGY1 Community Pharmacy Practice Resident, University of Maryland
School of Pharmacy

When you were a pharmacy student, did you ever experience interprofessional team teaching? Many will probably answer without hesitation, “Yes of course. On rounds during my acute
care rotation.” But consider these questions: What exactly is an interprofessional
team? How does an interprofessional team differ from a multidisciplinary team?

Although the terms multidisciplinary and interprofessional
are frequently used interchangeably, multidisciplinary teams differ from
interprofessional teams. Multidisciplinary and interprofessional teams differ
based on the degree of interaction and sharing of responsibilities.1
In patient care, multidisciplinary teams are described as being led by the
highest ranking team member which is usually the physician.1 Each member works independently but in
parallel. The medical record serves as
the primary tool for information sharing.1

In contrast, interprofessional healthcare teams include
members with different professional training coming together to
interdependently develop goals.1,2 In an interprofessional team,
leadership is shared, members engage each other and learn from one another.1
An interprofessional team approach involves the collaboration of people with diverse perspectives
to devise a unified approach.2 The aim of the interprofessional team
is to provide more comprehensive patient care than what is typically achieved
today.

Are there real benefits to adopting interprofessional team
teaching in healthcare education? Unlike
instruction received from people from a single professional background, interprofessional
teaching introduces multiple (two or more) perspectives in a teaching-learning
process that enhances each profession.3 Interprofessional teaching challenges students
to integrate alternative views and helps them to understand complex issues that
must be considered when providing optimal patient care.2 This approach also educates students about
conflict resolution and group dynamics, important skills that must be learned
in order to be an effective member of a high-functioning team.4

A recent paper described interprofessional education at the
Rosalind Franklin University of Medicine and Science, the University of
Florida, and the University of Washington.5 Each of these interprofessional education
programs included didactic instruction, a community-based experience, and an
interprofessional-simulation exercise.5 The didactic instruction taught
principles of collaborative patient centered care and clinical concepts.5
The community service component included interprofessional teams working with
community partners on a community service project.5 And the
simulation activity had students from different disciplines working together on
a skills assessment. All three interprofessional education programs felt they
had achieved their programmatic goals. Students
were reported to comprehend their professional roles and understood the
contribution of other professional’s roles on the team.5

One pilot study assessed an interprofessional team reasoning
framework

(IPTRF) utilized to teach and learn cases studies among
student of different health professions.6 The following flowchart is
the framework used in the study:

Eighteen students from dentistry, medicine, nursing,
occupational therapy, pharmacy, and physical therapy were randomized into 3
teams of six members.6 The first team received only the case; the second
received the case and framework; and the third received the case, framework,
and a videotaped example of interprofessional interactions. The primary end
point evaluated students’ perceptions and the secondary endpoint evaluated
students’ performances.6 The results found that students’ perception
of team skills improved when they were given the IPTRF tool (second and third
teams). Moreover, team three’s students’ performance was significantly better when
compared to students on the other two teams.6

The success of an interprofessoinal education lies in
developing a curriculum that prepares students to collaborate in an
interprofessional manner. One cannot expect recently graduated pharmacists to
successfully work within an interprofessional team without instruction, both
didactic and experiential. Many barriers exist in implementing
interdisciplinary team education including a lack of administrative/faculty
support, insufficient faculty with interdisciplinary training, limited
financial resources, entrenched power dispositions/territorial imperatives,
logistics, scheduling, and reimbursement.3

To progress, these barriers need to be addressed. Collaborators
from successful schools that have implemented interprofessional education indicated
that their success relied on resolving conflicts in the initial stages of
developing an interprofessional course.7 Collaborators need to understand each
other’s pedagogical views and negotiate those differences.7 Integral
to an interprofessional education are the core competencies identified by the
Interprofessional Education Collaborative Expert Panel.8

You may be wondering if I have experienced interprofessional
team teaching. I can honestly say, “Yes!” I took a class as a pharmacy student that
had interdisciplinary components. My Geriatric Imperative class had a geriatric
dementia team consisting of a physician, nurse, pharmacist, psychologist, and
social worker from the Veterans Affairs (VA).
The team members discussed how they met with their patients and shared their perspectives
to optimize each patient’s care. Later, as a P4 student, I rotated through the
Dementia clinic at the VA. For 3
months, I worked in this interdisciplinary team where we made assessments based
on our various perspectives, integrated the information, and together developed
a patient care plan.

December 16, 2012

In
2008, I had the life-changing opportunity to volunteer at a medical mission
camp in Bidada, Kutchh, India. The Kutchhi people lived in a rural, desert area
and travelled over 100 kilometers to get medical care at the Bidada Sarvodaya
Trust Hospital. Health care practitioners and volunteers flew in from all over
the world to provide care for these patients. For some volunteers, this was
their fifth trip. For others, like me, this was our first.

During our trip, we had multiple opportunities to educate and
provide medical services to the Kutchhi people, a population with a different language and culture than ours. This experience
sparked my interest in teaching because I was assigned to teach these patients
about how to properly use the medicines that we were dispensing. Patients would
quietly wait in line while I read a piece of paper and filled medications in a
little plastic bag. I learned how to say “take it once a day” in Kutchhi and give
other simple instructions on the proper administration of the medications. However
when patients were prescribed over five medications to take on a daily basis, I
really had to reassess my methods to make sure they understood what I was
saying. In an attempt to help patients
remember, I learned how to write the
directions. After I’d given written
instructions, I would ask the patient to teach me regarding the proper administration. However, when checking the
patient’s understanding of the regimen, I'd often get a blank stare. I had
explained the directions and wrote
them out, why hadn’t the patient understood? I learned the language, collaborated with the
local people, and provide both verbal and written instructions. What went wrong?

When
addressing cultural differences and learning how best to effectively
communicate, knowledge is key and understanding the audience is vital.1 As in any teaching plan, we need to:

prepare by performing strong background research

actively teach, learn to adapt, keep an open mind, and
be patient

evaluate and make changes when necessary

To effectively address cultural
differences, what research is required? First, self-knowledge and
self-awareness are needed. Before we can
try to understand someone else’s culture, we have to be aware of our own. Next
we should learn about our patients through observation and collaborating with a
local team member. Some questions to consider in your research include:

What
is the preferred style of the communication for the audience? Are the
communication preferences similar or different from our own? In the United
States we tend to be low-context communicators — meaning we speak directly. In
some cultures, people prefer high-context communication which involves speaking
in conceptual terms to get a point across. In
general, high-context communicators find nonverbal messages and gestures equally
if not more important than what’s verbally stated. Building a good relationship contributes to the
effectiveness of communication over time; and indirect routes and creative
thinking are important. In the Navajo culture, for example, if I told a
patient that his/her poor blood sugar control might one day lead to a limb amputation
if he/she doesn’t take the prescribed medications, the patient may feel
insulted and disrespected. Rather, if I
created a story of how a person with high blood sugar required an amputation
after not receiving treatment, the patient would be more motivated to learn and
intuit the importance of adherence with treatment.

Does
the audience believe in individualism or in communitarianism? Do members feel
like they each are entitled to make their own decisions or are decisions driven
by society and/or family. Understanding
this concept is vital to gaining the respect and trust from the individual and
community.

What is the audience’s baseline knowledge? Are they well educated regarding health
issues? Have they ever attended school? What is their level of literacy? Can they
read? Learning the answers to these questions up front is really important to
making certain the audience can understand our take home messages. As I learned, this was one step I neglected to
research.

After having the baseline research, how can we overcome language and
cultural barriers? Intercultural trainer, Kate Berardo, states we should:2

Speak slowly and clearly. Even if the patient speaks some English, its
hard to digest complex instructions. If
using a translator, simplify your statements and questions — discuss one issue
at a time.

Ask for clarification. If someone asks
questions, assess if you have answered the question and do not make
assumptions.

Frequently check for understanding. Engage the
learner by asking open-ended questions to see if your message is coming across as
intended.

Avoid idioms. Idiomatic phrases and slang terms that
are well understood in one culture, may not translate or make sense to someone
in another culture. Avoid them. Provide examples
of things they might be familiar instead. For example, when educating someone
about diet, talk about foods that are commonly eaten in that culture. Teaching
vegetarians to increase their protein intake by eating meat would be insensitive.
Rather teaching vegetarians to increase their protein source by consuming more
legumes and beans would be more effective.

Be careful of medical jargon. Use simple terms. Although as practitioners we may be
comfortable talking about hypertension, diabetes, condoms, etc, using these
terms may confuse or even insult some patients. Consider using simple terms
like high blood pressure, high blood sugar, and safe sex practices to get your
message across.

Be patient and attentive. They are trying
to understand us as much as we are them.

In my case, I could have prepared
better by asking the organizers more information about the patients and their
literacy levels. Fortunately, I checked
for understanding and asked the
patient to teach me about the
medications. In doing so, I realized that many patients were not able to read. I
was able to make changes in how I communicated to get the point across. I drew a sun and a moon and explained that the
sun meant morning and the moon meant evening. It was like a light bulb turning on and the
patient’s eyes gleamed with happiness. When asked again, the patient was able
to explain how to appropriately take the medications. I now realized the importance of doing an
analysis and truly understanding your audience before delivering instruction.
Without preparation before and evaluation after, we can’t overcome cultural
barriers and educate patients. But, the
same is true for any teaching assignment.

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